Implementation barriers in Singapore's community-based falls prevention programmes: a root cause analysis

Falls are a critical public health challenge for ageing populations. Despite robust evidence supporting the clinical effectiveness of multi-component falls prevention programmes (FPPs), a pronounced implementation gap exists in community settings. This study investigates systemic barriers to delivering FPPs in Singapore, focusing on resource constraints, operational capacities, and scaling risks.

This qualitative study employed a structured Facilitated Process Improvement workshop grounded in the Theory of Constraints. Fourteen management representatives from seven diverse Integrated Community Care Providers participated in the half-day workshop. The workshop featured three core activities: (i) capacity mapping of current and projected FPPs delivery capabilities, identification of (ii) challenges in falls risk screening processes and (iii) barriers in programme monitoring and evaluation. Workshop discussions were moderated through probing and clarifying using Categories of Legitimate Reservation, a logical framework to ensure all identified challenges were clearly defined and the causal linkages proposed were logically sound. Workshop insights were systematically analysed through the construction of a Current Reality Tree to map fundamental constraints.

The core undesirable effect was the continued prevalence of avoidable injurious falls. Root causes identified included: (1) no systematic effort to inform older adults about falls and falls prevention, (2) community provider lack of training resources, (3) community provider insufficient funding, (4) a lack of both formal and informal data on demand for FPPs, and (5) high manpower cost for vendors to conduct FPPs. Findings from the CRT analysis are organised into three themes: (a) older adult perception and awareness, (b) provider operational capacities, and (c) inconsistent vendor supply. Findings reveal three systemic gaps: an information gap obscuring need, a resource/capacity gap crippling delivery, and an economic gap making programmes unsustainable.

Effective scaling requires moving beyond funding discrete programmes to investing in the foundational pillars of the preventive health ecosystem in Singapore. Addressing information gaps, resource, and economic gaps identified in this study is a necessary step towards making falls prevention a scalable and sustained reality.